Spine Information
Low Back Pain in Athletes
Table of Contents
Athletes are at greater risk of sustaining a lumber (lower) spine
injury due to physical activity. Whether the sport is skiing,
basketball, football, gymnastics, soccer, running, golf, or tennis-the
spine undergoes a lot of stress, absorption of pressure, twisting,
turning, and even bodily impact. This strenuous activity puts stress on
the back that can cause injury to even the finest and most fit
athletes.
Though the entire spine is used when playing sports, it is estimated
that five to ten percent of all athletic injuries are related to the
lumbar spine. Many cases of low back pain in athletes can be traced to
a specific event or trauma; others are brought about by repetitive
minor injuries.
It is sometimes hard for an aggressive athlete to consider changing
training schedules. It is also hard to accept the fact that a serious
disease may exist. All athletes who suffer from low back pain should
seek medical advice. Some situations might require reducing or ceasing
athletic activity until the problem is resolved. The body's ability to
be active is worth preserving.
Learn about low back pain in athletes including
- how the spine is affected
- what generally causes low back pain in athletes
- how a diagnosis is made
- what treatment options are available
In order to understand your symptoms and treatment choices, it is
helpful to start with a basic understanding of the anatomy of the low
back. This includes becoming familiar with the various parts that make
up the lumbar spine and how they work together.
Even though low back pain can sometimes be treated without major
disruption to a person's life, athletes are often reluctant to seek
medical help. Many of them deny or minimize complaints in order to
avoid consequences, such as: having to decrease activity in order to
recover, losing a position or being removed from a team, missing a
competition, or letting the team down. Some athletes simply do not want
to bother seeing a doctor for pain; they hope it will recover on its
own.
Many athletes-from the weekend warrior to the elite professional
athlete-buck up their strength, pop some over-the-counter pain
medication, and tolerate the pain for the sake of the game and personal
enjoyment. But avoiding medical help can lead to further and more
serious injury. Without medical help, the anatomic damage can sometimes
lead to permanent exclusion from sporting activities.
There are many causes of low back pain. The most common causes in
athletes are back strain, spondylolysis, spondylolisthesis, and
herniated discs.
Back Strain
The medical term used to describe common back strain is
musculoligamentous strain. This term refers to all injuries of the
lumbar spine's soft tissue. Soft tissues are the muscles, nerves,
ligaments, tendons, and blood vessels around the spine. These are
probably the most common types of sports injuries. Back strains are
diagnosed by exclusion, which means the diagnosis is offered after all
other causes of pain are ruled out. These injuries are usually
self-limiting. In other words they do not continue to spread and get
worse; they generally heal in time.
Spondylolysis and Spondylolisthesis
A crack in the bony ring of the spinal column is called
spondylolysis. If the crack occurs on both sides of the bony ring, the
spine is free to slip forward, a condition called spondylolisthesis. So
far there is no definitive cause of spondylolysis. Most physicians
agree that the bone defect appears in children mainly due to sports
activities that put repeated stress on the pars interarticularis. The
spondylolysis appears in younger and older adults as the result of
excessive stresses on the spine, eventually causing a stress fracture.
Spondylolysis in athletes is most commonly found in those who
participate in sports that have frequent hyperextension of the lumbar
spine, such as gymnastics, pole-vaulting, and football. Weightlifters
also have a higher incidence of the disorder due to excessive stress on
the spine.
Spondylolysis does not always produce noticeable symptoms. When
it does, chronic low back pain is the most common symptom. The pain can
stem from mechanical (structural) or compressive (pressure on nerves)
pain.
Spondylolisthesis occurs when the weakness caused by the spondylolysis
causes one vertebra to slip forward
over the one below it. Most cases of spondylolysis in athletes do not
lead to vertebral slippage. But if slippage does occur it may continue.
This situation requires more aggressive treatment-perhaps even surgery.
The chance of progression is probably more worrisome in teenagers than
adults.
Many cases are non-symptomatic and do not cause any nerve problems.
Sometimes the slipped vertebra can press into the space of the spinal
canal. This leaves less room for the nerve roots. The neural pressure
can lead to low back, buttock, and leg pain, as well as numbness in the
foot. Surgery may be suggested if the problem is severe.
Herniated Discs
Many sports produce high amounts of pressure on the spine. Over
time, these repeated stresses add up and begin to affect the discs in
the spine.
A herniated disc
occurs when pressure to a disc's outer fibers (annulus) is so great
that it rips, and the nucleus ruptures out of its normal space. If it
rips near the spinal canal, the bulging disc can push out of its space
and into the spinal canal, placing inappropriate pressure on the spinal
cord and nerve roots. If a disc bulges substantially, or fragments into
pieces that lie in the canal, then irritation of the nerves can be
severe.
The compression to the nerves caused by herniation can lead to
feelings of numbness, pain, a change in reflexes, and tingling in the
arms or legs. In addition, if a disc ruptures, it releases chemicals
that can irritate and inflame the nerve roots, which leads to extreme
discomfort. Sometimes a herniated disc is referred to as "slipped
disc," though the disc does not actually slip.
Other Causes
Adolescent athletes may also suffer from low back pain that is
caused by growth-related problems, such as scoliosis and Scheuermann's
kyphosis. These problems may or may not be related to athletic
activity. But they can affect an athlete's ability to perform up to his
or her standards.
Scoliosis
Scoliosis is a condition that is related to growth. It appears
usually just as the teenage growth spurt of puberty begins and may
progress through the growth phase. The growth spurt begins at about age
11 in girls and age 13 in boys. Scoliosis is usually painless, but it
may cause back discomfort with activity. The condition is genetic,
which means it runs in families. It is more common in girls than boys.
If the condition progresses, it can be serious. It may require
treatment with a brace, or even surgery.
Scheuermann's Kyphosis
Scheuermann's kyphosis is a developmental type of kyphosis. The
vertebrae are normally rectangular-shaped and stacked on top of one
another, like building blocks, with a soft cushion (disc) in between
each one. If they wedge closer together in a triangular shape, as with
Scheuermann's kyphosis, it causes the spine to curve more than normal.
Sometimes this deformity is described as "round-back posture" or
"hunch-back."
In evaluating low back pain in athletes, your doctor will start by gathering
information about the current problem and a complete history
of any additional medical problems. Athletes tend to live with a
certain amount of constant pain. This can cause them to ignore or
minimize the severity of their pain. They may also be used to dealing
with more pain than the average patient, which sometimes makes it
harder to adequately assess their symptoms. This is why a thorough
history of the athlete is needed.
Before determining a diagnosis and developing a treatment plan, your physician will need to know
- your age
- the type(s) of sport(s) and level of competition in which you are involved
- all past and current medical problems
- the location of the pain and where it spreads
- when the pain began, along with the pain's relation to any specific trauma
- what brings pain on or relieves it
- about any drug or medication use
Physical Exam
Your doctor will examine your entire spine looking for signs of
unusual curves, a rib hump, a tilted pelvis, and tilting of the
shoulders. Your muscle strength will be tested, as well as your
reflexes, sensation, and ability to perform specific movements. You may
have to undergo further tests if your doctor feels there is need for
more information.
Conservative Treatment
The majority of low back pain in athletes can be treated with
conservative means. Treatments will vary depending on the cause of
pain. Back strains may simply require a short period of limited
activity, medication, and ice applications. When symptoms ease,
athletes are usually able to resume their sport activity gradually,
applying concepts of proper conditioning and warm ups.
Athletes with spondylolysis and spondylolisthesis may require the
use of a brace, along with rigorous avoidance of the sport activity.
The brace is commonly prescribed for three months, after which athletes
gradually return to their sports activities. The treatment for a
herniated disc depends on the symptoms and degree of nerve irritation
or dysfunction. Herniated discs can usually be treated without surgery.
Medication
Your doctor may prescribe anti-inflammatory medications to reduce pain and swelling.
Ice
If the injury just happened, your doctor may instruct you to apply
ice to the sore area. Cold packs are typically applied for 15 to 20
minutes. Some doctors recommend the use of contrast applications. This
is accomplished by alternating cold and hot packs every five minutes
over the sore area.
Specific Rest
Immediately after a back injury, rest is often all your back needs
to feel better. Rest is used to take the pressure off your spine and
the muscles around it. You should rest in a comfortable position on a
firm mattress. Doctors usually advise against bed rest for more than
two days. Staying in bed longer than two days can weaken key muscles of
the trunk. In most cases of sudden back pain, the sooner you start
moving again, the sooner your back pain will improve.
Bracing
If a spine specialist feels you may have a true stress fracture from
athletic activity, you might be placed in a back brace (24 hours a day)
for several months to allow the fracture to heal. You will then be
gradually weaned from the brace and allowed to return to full activity.
Surgery is rarely considered for these problems.
Physical Therapy
Your doctor may have you work with a physical therapist. A
well-rounded rehabilitation program assists in calming pain and
inflammation, improving your mobility and strength, and helping you get
back to optimal performance with sport activities.
Athletes understand that exercise is very important in order to
strengthen the abdominal, paraspinal, and pelvic muscles. Strong
muscles in these areas can take pressure off the spine and help prevent
back injuries. A physical therapist can help a patient develop a
beneficial routine of conditioning and rehabilitation that includes
proper warm-ups (such as back stretching exercises) and aerobic
exercise.
The goals of physical therapy are to help you
- apply proper conditioning, warm-ups, and cool downs
- use proper technique in your sport activity
- choose appropriate equipment for your sport
- maximize your flexibility and core strength
- learn ways to manage your condition
ESI
An epidural steroid injection (ESI)
is usually reserved for more severe pain from nerve root irritation due
to a herniated disc. The steroid injections are a combination of
cortisone (a powerful anti-inflammatory steroid) and a local anesthetic
that are given through the back into the epidural space. It is not
usually suggested unless conservative treatments are not helping and
surgery is fast becoming an option. An ESI is only successful in
reducing the pain from a herniated disc in about half the cases.
Surgical Treatment
Spondylolysis and Spondylolisthesis
Surgical treatment for spondylolysis and spondylolisthesis is
necessary only in the event that conservative treatments fail to keep
your pain at a tolerable level. The surgery must address the presence
of mechanical and compressive symptoms.
Nerve pressure may require surgical decompression, called
decompressive laminectomy of the lumbar spine. In order to free up or
"decompress" the nerves, the surgeon must remove a section of bone from
the back of the spine (lamina). The surgeon may also have to remove
a portion of the facet joints. The lamina and facet joints normally
provide stability in the spine. Removal of either or both can cause the
spine to become loose and unstable. When this occurs, doctors will
include fusion. Likewise, patients needing surgery for spinal
instability due to spondylolisthesis typically require lumbar fusion.
Herniated Disc
Surgical treatment for a herniated disc depends on several factors such as your specific problem and your surgeon's experience.
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